Five ranked causes of one composite woman's fatigue, set out as an MN566 Unit 4 worksheet whose every row names the result that would move that candidate higher. Searches like "mn 566 unit 4 assignment example", "mn566 unit 4 sample" and "mn566 unit 4 example" land here.
Differential Diagnosis Worksheet: A School Librarian, Aged 41, Tired for Three Months
[Student Name]
Purdue University Global
MN566: NP I - Introduction to Primary Care for the Nurse Practitioner
Unit 4 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Test thresholds are given for teaching; nothing here replaces local laboratory ranges.
Case Summary
Composite 41-year-old woman, elementary school librarian, with three months of tiredness on waking and through the day. Heavy menstrual periods for a year, soaking a pad every two hours on the heaviest days. Weight gain of 4 kg over six months, and she feels cold when others do not. Her partner reports loud snoring. PHQ-2 score 3. No fever, night sweats, weight loss or new lumps.
Ranked Differential
1. Iron deficiency anemia. Supporting: a year of heavy menstrual bleeding, tiredness on waking. Against: no reported shortness of breath on exertion or craving for ice. Discriminating test: complete blood count with ferritin. What would move it up: a ferritin below 30 ng/mL, which in an adult is strong evidence of depleted iron stores (Camaschella, 2015). Must-not-miss: no.
2. Hypothyroidism. Supporting: weight gain, cold intolerance, fatigue. Against: no constipation, dry skin or hoarseness reported. Discriminating test: TSH. What would move it up: a raised TSH, followed by a free T4. Must-not-miss: no.
3. Obstructive sleep apnea. Supporting: loud snoring reported by her partner, tiredness on waking, weight gain. Against: no witnessed pauses in breathing reported, and her neck size and blood pressure are not yet recorded. Discriminating test: STOP-Bang questionnaire (Chung et al., 2008), leading to a sleep study if the score is high. What would move it up: a STOP-Bang score of 3 or more, or witnessed apneas. Must-not-miss: no.
4. Depression. Supporting: PHQ-2 score of 3, which is the usual cutoff for a positive screen (Kroenke et al., 2003); fatigue is common in depression. Against: she describes no loss of interest in her work or family when asked. Discriminating test: PHQ-9. What would move it up: a PHQ-9 of 10 or more with depressed mood or loss of interest. Must-not-miss: suicidal thoughts must be asked about with the PHQ-9.
5. Type 2 diabetes. Supporting: weight gain, fatigue. Against: no thirst, frequent urination or blurred vision. Discriminating test: A1C. What would move it up: an A1C of 6.5 percent or more. Must-not-miss: no.
Below the Ruled Line
Malignancy, including lymphoma and cancers causing blood loss. Must-not-miss because fatigue can be its first symptom. Red flags absent: no unintended weight loss, no night sweats, no fever, no new lumps, no rectal bleeding or change in bowel habit. It sits outside the ranking because nothing in the case supports it, but it would move above the line if any red flag appeared or if the blood count showed an unexplained abnormality beyond iron deficiency.
Synthesis
Working diagnosis: iron deficiency anemia from heavy menstrual bleeding, with hypothyroidism a close second. First tests, ordered together today: complete blood count, ferritin, TSH and A1C, since all are drawn from one sample and the first two rows are the most likely. The PHQ-9 and STOP-Bang are completed at this visit, because they cost only minutes and address rows three and four. The order follows the ranking, with inexpensive tests for lower rows added because they need no extra visit. If ferritin is low, her heavy bleeding needs its own evaluation, and a gynecology referral is considered. Results will be reviewed with her by phone within one week, and a follow-up visit is booked for two weeks.
References
Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832-1843. https://doi.org/10.1056/NEJMra1401038
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C. M. (2008). STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108(5), 812-821. https://doi.org/10.1097/ALN.0b013e31816d83e4
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284-1292. https://doi.org/10.1097/01.MLR.0000093487.78664.3C
How this MN566 Unit 4 example is structured
The case summary is held to five lines so the table carries the reasoning. Rows run in rank order, numbered at the left edge. Supporting and opposing findings are drawn only from the case. The discriminating test column names one test per row: a complete blood count with ferritin, a TSH, a validated sleep questionnaire leading to a sleep study, a PHQ-9, and an A1C. The column headed what would move it up is the distinctive part of this worksheet; it states a concrete result, such as a ferritin below threshold, that would reorder the list. The must-not-miss row sits beneath a ruled line so it is visibly outside the ranking. A synthesis paragraph closes by stating the working diagnosis, the order of testing and the interval for reviewing results with the patient.
Get an MN566 Unit 4 example written to your instructions
Send the Unit 4 case and the worksheet template your MN566 section uses, whether a table, a numbered list or a free-text form. The first worksheet is written free of charge to that template and returns within 24-48h, with a ranked list, a discriminating test beside each candidate, and the result that would reorder it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN566 Unit 4 questions, answered
How many diagnoses belong on the worksheet?
Usually three to six ranked candidates plus one or two must-not-miss conditions. Fewer than three rarely shows real differential thinking; more than six tends to include entries with no support in the case. Check whether your section sets a number. If it does not, stop adding candidates when the next one would have nothing from the history or exam behind it.
Can the worksheet change the ranking after test results?
If your case includes results, yes, and showing the change is valuable. Some sections release a second stage of data; the worksheet then records the original rank, the new result and the revised rank with a sentence of explanation. Where no results are given, the promotion column does that work hypothetically by stating which result would reorder the list.
Should rare conditions be included to show breadth?
Only when something in the case points toward them or when missing them would be dangerous. Breadth for its own sake reads as listing from a textbook. A rare condition with real support belongs in the ranking; a dangerous one without support belongs below the line with its absent warning features named; a rare and harmless one with no support belongs nowhere.